Provider Demographics
NPI:1730482167
Name:PULLINS, MICAH DAVID (DO)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:DAVID
Last Name:PULLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 BROWNING WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8340
Mailing Address - Country:US
Mailing Address - Phone:775-777-3535
Mailing Address - Fax:775-777-3559
Practice Address - Street 1:1775 BROWNING WAY STE 201
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8340
Practice Address - Country:US
Practice Address - Phone:775-777-3535
Practice Address - Fax:775-777-3559
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9494A207X00000X
MI5101017901207X00000X
NVDO2109207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW25532OtherMEDICARE
WY1730482167Medicaid